Dr. Lola Susianti, Sppd-Finasim
Dr. Lola Susianti, Sppd-Finasim
Dr.dr LOLA
LOLA SUSIANTI
SUSIANTI, SpPD-FINASIM
SpPD-FINASIM
RIWAYAT PENDIDIKAN
DR UMUM FK UNAND 2000
SP PENYAKIT DALAM FK UNAND 2014
nociceptive acute
PAIN
neuropathic chronic
Nociceptive vs Neuropathic Pain
Nociceptive Mixed Type Neuropathic
Pain Caused by a Pain
combination of both
Disebabkan oleh Dipicu oleh lesi primer
primary injury and
aktivitas pada neural atau disfungsi sistim
secondary effects
patway sebagai respon syaraf
menanggapi
rangsangan berpotensi
merusak jaringan CRPS*
Postherpetic
Postoperative Trigeminal
neuralgia
pain Arthritis neuralgia
NON PHARMACOLOGIC
Mechanism of Action of NSAIDs
Normal condition Inflammation
Arachidonic acid
COX-1 COX-2
(constitutive) X T-NSAIDs X (inducible)
(
PGH2 PGH2
• GI protection
• vasodilation • inflammation
• renal perfusion
• pain
• fever
• inhibit platelet aggregation
NSAID=nonsteroidal anti-inflammatory drug; COX=cyclooxygenase. Adapted from Wallace JL. Am J Med. 1999;107(6A):11S–17S; Hinz B, et al. J Pharmacol Exp Ther. 2002;300(2):367–375;
IS
Vanegas H, et al.; Prog Neurobiol. 2001;64(4):327–363; Furst DE. Am J Med. 1999;107(6A):18S–26S; 7 Ther.
Vane JR, et al. Annu Rev Pharmacol Toxicol. 1998;38:97–120; Fung HB, et al. Clin
1999;21(7):1131–1157.
Less GI side effects
More GI side effects
Diclofenac Etoricoxib
Acetosal Indomethacin Ibuprofen
Ketorolac Piroxicam Ketoprofen
Meloxicam COXIB
Celecoxib
Nimesulide Valdecoxib
anti-inflammatory
analgesic
Etoricoxib
Etoricoxib is a second generation coxib/selective COX-2.
Nyeri
Deformitas
Keterbatasan gerak
NSAIDs in OA Recommendation
–10
Mean change from
p<0.001
–30
p=NS
–40
–50 Less
pain
R 2 4 6 8 14 20 26 34 42 52
Placebo- Active-comparator–controlled
controlled
Weeks postrandomization
Re-randomization took place at week 6
NS = not significant
*0- to 100-mm visual analog scale (VAS) (0 = no pain to 100 = extreme pain)
Adapted from Gottesdiener K et al Rheumatology 2002;41:1052–1061; Curtis S et al. Poster presented at EULAR, 2001.
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Rheumatoid Arthritis
Rheumatoid
Severe joint erosions nodul
causes joint deformities
EULAR = European League Againts Reumatism
Unsurpassed safety
profile of Etoricoxib :
- Better GI safety
- Comparable CV
safety
MEDAL Program: Confirmed
Upper GI Events
3.0
Etoricoxib 60 and 90 mg pooled (176 events)
Diclofenac 150 mg (246 events) All confirmed
2.5
eventsa
Cumulative Incidence,
Etoricoxib vs diclofenac
HR=0.69 (95% CI: 0.57, 0.83) P=0.0001
2.0
% (95% CI)
1.5
1.0 Complicated
events
P=0.561
0.5
Etoricoxib vs diclofenac
HR=0.91 (95% CI: 0.67, 1.24)
0
0 6 12 18 24 30 36 42
Months
Patients at risk for upper GI events, no.
Etoricoxib 17,412 13,704 10,972 8400 6509 4063 821
Diclofenac 17,289 13,190 10,396 8027 6306 3867 820
P<0.001b Etoricoxib
20 Diclofenac 150 mg
17.13
15
Rate/100 PY
P<0.001b P<0.001b
3.96 4.41
5
0
60 mg/d vs 90 mg/d vs 90 mg/d vs
Diclofenac Diclofenac Diclofenac
Patients With OA Patients With RA
Putri, RSI et al. 2016. Summary Report of Bioequivalence Study. Data on file
KESIMPILAN
• NSAID termasuk COX2 inhibitor adalah obat
yg paling sering digunakan untuk nyeri kronis
pada OA dan RA.
• Etoricoxib menunjukkan efikasi yg sebanding
dg NSAID konvensional pada kasus OA danRA
• Etoricoxib (Orinox) mempunyai efek samping
GI paling rendah
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